Question 1
S. is a 59-year-old female who has been followed for several years for aortic
regurgitation. Serial echocardiography has demonstrated normal ventricular function,
but the patient was lost to follow-up for t
...
Question 1
S. is a 59-year-old female who has been followed for several years for aortic
regurgitation. Serial echocardiography has demonstrated normal ventricular function,
but the patient was lost to follow-up for the last 16 months and now presents
complaining of activity intolerance and weight gain. Physical examination reveals a
grade IV/VI diastolic aortic murmur and 2+ lower extremity edema to the midcalf. The
AGACNP considers which of the following as the most appropriate management
strategy?
A. Serial echocardiography every 6 months B. Begin a calcium channel antagonist
C. Begin an angiotensin converting enzyme (ACE) inhibitor D. Surgical
consultation and intervention
C. Begin an angiotensin converting enzyme (ACE) inhibitor
The patient is having grade 6 diastolic aortic murmur. The murmur is not accompanied by any
serious complications because there is a 2+ lower extremity edema to the midcalf. Angiotensin
converting enzyme (ACE) inhibitor lowers the blood pressure. High blood pressure often
worsens the underlying conditions that cause heart murmurs. Beginning an angiotensin
converting enzyme (ACE) inhibitor will help in the management of diastolic aortic murmur by
dealing with the conditions that cause heart murmurs. A surgery would be used only when the
valves are damaged or leaky
Reference
https://www.mayoclinic.org/diseases-conditions/heart-murmurs/diagnosis-treatment/drc20373175
Question 2
An ascending thoracic aneurysm of > 5.5 cm is universally considered an indication for
surgical repair, given the poor outcomes with sudden rupture. Regardless of the
aneurysm’s size, all of the following are additional indications for immediate operation
except:
A. Comorbid Marfan’s syndrome B. Enlargement of > 1 cm since diagnosis C.
Crushing chest pain D. History of giant cell arteritis
C. crushing chest pain
Prophylactic surgery is recommended when the aorta reaches a diameter of 5.5 cm, when the
patient falls under the Marfan syndrome bicuspid aortic valve category, when the enlargement
is greater than 0.5 cm, and when the patient has a history of fast-growing cell arteritis. Marfan
syndrome is a connective tissue condition that involves the respiratory, skeletal, cardiovascular
and ocular systems. It is one of the most serious complication of aortic valve regurgitations
and needs an immediate surgery. For this reason, a crushing chest pain is the odd one out
Reference
https://www.sciencedirect.com/science/article/pii/S235290671500010X
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